From the Guidelines
Candidal stomatitis is best treated with antifungal medications, with the specific approach depending on severity, and according to the most recent guidelines, fluconazole is recommended for moderate to severe disease at a dosage of 100–200 mg daily for 7–14 days 1.
Treatment Approach
For mild disease, topical antifungals such as clotrimazole troches at a dosage of 10 mg 5 times daily or nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL 4 times daily are recommended 1.
- Key considerations include:
- Maintaining good oral hygiene
- Removing dentures at night and disinfecting them
- Avoiding broad-spectrum antibiotics when possible
- Controlling underlying conditions like diabetes
Systemic Therapy
For more severe or resistant cases, systemic therapy may be necessary, such as fluconazole, which has been shown to be effective in treating oropharyngeal candidiasis 1.
- The dosage of fluconazole for moderate to severe disease is 100–200 mg daily for 7–14 days.
- In cases of fluconazole-refractory disease, itraconazole solution or posaconazole suspension may be used as alternative treatments 1.
Recurrent Infections
Recurrent infections typically occur in patients who have persistent immunosuppression, especially those who have AIDS and low CD4 cell counts (<50 cells/μL) 1.
- Long-term suppressive therapy with fluconazole has been shown to be effective in preventing oropharyngeal candidiasis, but it is associated with increased in vitro resistance 1.
- Antiretroviral therapy should be used whenever possible for HIV-infected patients with oropharyngeal or esophageal candidiasis to reduce the frequency of symptomatic infections 1.
From the FDA Drug Label
Nystatin Oral Suspension, USP, is indicated for the treatment of candidiasis in the oral cavity. The recommended dosage of SPORANOX ® (itraconazole) Oral Solution for oropharyngeal candidiasis is 200 mg (20 mL) daily for 1 to 2 weeks.
Treatment Options for candidal stomatitis include:
- Nystatin (PO): indicated for the treatment of candidiasis in the oral cavity 2
- Itraconazole (PO): recommended dosage is 200 mg (20 mL) daily for 1 to 2 weeks for oropharyngeal candidiasis 3
From the Research
Treatment Options for Candidal Stomatitis
- Nystatin pastille has been shown to be significantly superior to placebo in treating denture stomatitis 4
- Nystatin suspension was not superior to fluconazole in treating oral candidiasis in infants, children, or HIV/AIDS patients 4
- Posaconazole and voriconazole have excellent in vitro activities against all Candida isolates and could represent useful alternatives for recalcitrant or recurrent candidiasis 5
- Antifungal agents are available in various forms, each with differing indications, dosing regimens, adverse effects, and drug interactions 6
Antifungal Agents
- Polyenes (nystatin, amphotericin B) are available as oral suspensions, pastilles, or creams 6
- Azoles (ketoconazole, miconazole, clotrimazole, fluconazole, itraconazole, voriconazole, posaconazole, isavuconazole) are available as oral suspensions, pastilles, or creams, or administered systemically in capsule or intravenous form 6
- Echinocandins (caspofungin, micafungin, anidulafungin) are discussed as treatment options for candidiasis 6
Alternative Therapies
- Probiotics are being explored as a novel approach in antifungal therapy 6
- Nanotechnology has dominated recent research, with several nanoparticles demonstrating antifungal effects 7
- Incorporation of antifungal/antimicrobial agents into the polymethyl methacrylate (PMMA) denture base may have a superior effect in preventing denture stomatitis 7